Clinton’s Pneumonia: Experts Weigh-In

Surce:medpagetoday.com
September 12, 2016
Hillary Clinton’s physician’s diagnosis of pneumonia following an incident at a Sept. 11th memorial event on Sunday is consistent with Clinton’s symptoms, according to experts.
“Her course and the associated symptoms … are really consistent with how she looked on video the other day,” said Jonathan Parsons, MD, professor of internal medicine in the division of pulmonary and critical care medicine at The Ohio State University, in Columbus, told MedPage Today in a phone interview. “Absolutely … if she was dehydrated or her blood pressure was low or she was dizzy — all symptoms that can be associated with significant pneumonia — it could be associated with that for sure.”
Clinton left the event on Sunday after about 90 minutes, complaining of feeling overheated, according to media reports. Video showed her stumbling and appearing to buckle at the knees as she was being helped to her car. After being taken to her daughter Chelsea’s residence, Clinton emerged outside a while later and appeared to be feeling much better. The incident Sunday came a few days after Clinton had a coughing fit at Labor Day rally in Cleveland, which the campaign attributed to allergies. On Sunday, Clinton’s physician released a statement saying Clinton had been diagnosed with pneumonia and was on antibiotics.
“Patients can get dehydrated such as she did, and pneumonia, even if it’s of the milder ‘walking pneumonia’ variety, can make you feel woozy and not up to sorts,” said William Schaffner, MD, professor and chair of the preventive medicine at Vanderbilt University in Nashville and past secretary of the Infectious Diseases Society of America. “I am very happy that she is taking a day or two off,” he added, noting that he was speaking from a medical standpoint and not a political one.
Schaffner said he was not surprised that Clinton had been diagnosed with pneumonia. “It seems likely that was a viral infection she acquired, and over time that infection was complicated by pneumonia; that’s a common course of events. She is face to face with thousands of people in their breathing zone — 3-6 feet — and that’s an ideal circumstance to pick up someone’s viral infection … Bacterial pneumonia can be a complication of that.”
Uncertainty about Clinton’s diagnosis — with her coughing fit first being attributed to allergies — is often typical with pneumonia, experts said.
“Symptoms can be very vague at the beginning — feeling congested, feeling tired, with potentially a loss of appetite and maybe a cough,” said Christian Merlo, MD, associate professor of medicine at Johns Hopkins University, in Baltimore. “And some of those symptoms are similar to those of allergies; however, if you’re really short of breath, if you’re not just coughing but bringing up phlegm, then that suggests something a little bit more than allergies.”
“Sometimes these things come on gradually and it’s hard to make a diagnosis at the outset, and as things progress it becomes more evident what’s going on,” said Parsons. “So I’m not surprised there was not a definitive diagnosis when this started.”
“There are classical signs of any process or disease, but bear in mind that only a minority of patients have all the classical signs,” said Ephraim Tsalik, MD, PhD, assistant professor of infectious diseases at Duke University, in Durham, N.C. “Coughing, certainly, is one of the signs of pneumonia. other common things will be fever, sometimes chest pain from inflammation of the lung, but that doesn’t have to be present — people are usually just feeling crummy; they’ve lost their appetite, and they have no strength.”
The course of pneumonia can vary greatly, from “very very mild, where someone doesn’t have to go to hospital where given treatment in an outpatient setting, to very severe where end up in the hospital in the intensive care unit with a breathing tube and mechanical ventilation. So the spectrum is very broad,” said Merlo. But there is general agreement that patients recover more quickly from the bacterial form of pneumonia than the viral form.
With bacterial pneumonia, “the significant symptoms get better within a few days with appropriate antibiotic treatment, ” said Parsons. “With viral pneumonia, it typically turns course in 10-14 days and patients feel better within 5-7 days. So with rest and appropriate treatment she should recover within a week.”
One problem with treating pneumonia is that often there is no way to tell whether it’s viral or bacterial, noted Tsalik. “In the majority of cases, they have no clue despite getting all the tests available,” he said, adding that most of the tests out there have limitations. “The assumption is in the majority of cases it’s bacterial” and most doctors will prescribe an antibiotic just to be on the safe side.
Of course, there are standard things to watch for that would be signs things are getting worse: persistent cough, a cough that produces yellow or green sputum, sputum streaked with blood, chest pain, and shortness of breath, said Schaffner. “And obviously increasing fever, persistent fever, chills, all of those would suggest it’s not optimally being treated and needs further diagnostic evaluation.”
Clinton’s diagnosis is also a good reminder for people 65 and older to get their pneumococcal vaccine, Schaffner said. “I’d hope both of the [major party] candidates, who are both age 65 plus, are appropriately vaccinated, and this is an opportunity to get the word out that people age 65 and older ought to get the vaccine.”